Outcome and Prognosis in Critically Ill Children Receiving Continuous Renal Replacement Therapy.
- Author:
Kwang Sik PARK
1
;
Ki Young SON
;
You Sik HWANG
;
Joung A KIM
;
Il Chun CHEUNG
;
Jae Il SHIN
;
Ji Min PARK
;
Sun Young AHN
;
Chuhl Joo LYU
;
Jae Seung LEE
Author Information
1. Department of Pediatrics, Severance Childrens Hospital, The Institute of Kidney Disease, Yonsei University College of Medicine, Seoul, Korea. jsyonse@yumc.yonsei.ac.kr
- Publication Type:Original Article
- Keywords:
Acute renal failure;
Continuous renal replacement therapy;
Fluid overload;
Children
- MeSH:
Acute Kidney Injury;
Body Weight;
Bone Marrow Transplantation;
C-Reactive Protein;
Cause of Death;
Child*;
Critical Illness*;
Filtration;
Humans;
Korea;
Medical Records;
Multivariate Analysis;
Prognosis*;
Renal Replacement Therapy*;
Retrospective Studies;
Survival Rate;
Survivors;
Urea
- From:Journal of the Korean Society of Pediatric Nephrology
2007;11(2):247-254
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Continuous renal replacement therapy(CRRT) has been the first choice for the treatment of acute renal failure in critically ill children not only in western countries but also in Korea. However, there are very few studies that have analyzed the outcome and prognosis of this modality in Korean children. We performed this study to evaluate the factors associated with the outcome and prognosis of patients treated with CRRT. METHODS: We retrospectively reviewed the medical records of 32 children who had received CRRT at Severance hospital from 2003 to 2006. The mean age was 7.5 years(range 4 days- 16 years) and the mean body weight was 25.8 kg (range 3.2-63 kg). RESULTS: Eleven(34.4%) of the 32 patients survived. Bone marrow transplantation and malignancy were the most common causes of death and underlying disease leading to the need for CRRT. Mean patient weight, age, duration of CRRT, number of organ failures, urine output, estimated glomerular filtration rate(eGFR), C-reactive protein, and blood urea level did not differ significantly between survivors and nonsurvivors. (1) Pediatric risk of mortality(PRISM) III score at CRRT initiation(9.8+/-5.3 vs. 26.7+/-7.6, P<0.0001), (2) maximum pressor number (2.1+/-1.2 vs. 3.0+/-1.0, P=0.038), and (3) the degree of fluid overload(5.2+/-6.0 vs. 15.0+/-8.9, P=0.002) were significantly lower in survivors than in nonsurvivors. Multivariate analysis revealed that fluid overload was the only independent factor reducing survival rate. CONCLUSION: CRRT was successfully applied to the treatment of acute renal failure in a wide range of critically ill children. To improve survival, we suggest the early initiation of CRRT to prevent the systemic worsening and progression of fluid overload in critically ill children with acute renal failure.
